Provider Demographics
NPI:1144407578
Name:LIFELINE SENIOR SERVICES
Entity Type:Organization
Organization Name:LIFELINE SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-774-7414
Mailing Address - Street 1:PO BOX 3792
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-3792
Mailing Address - Country:US
Mailing Address - Phone:803-774-7414
Mailing Address - Fax:803-774-6325
Practice Address - Street 1:214 W LIBERTY ST STE 2
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-5181
Practice Address - Country:US
Practice Address - Phone:803-774-7414
Practice Address - Fax:803-774-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies